Permit C ITY OF TIGARD PLUMBING PERMIT
4 ' f 4 * DEVELOPMENT SERVICES PERMIT #: P 27120% -00393
1,L .. I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 - DATE ISSUED: 8/27/2004
SITE ADDRESS: 12052 SW WHISTLER'S LP PARCEL: 2S103CC -12000
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 067 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES [PLUMB] Permit Fee 8/27/2004 $36.25
4230 GALEWOOD ST., #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 8/27/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 - 692 - 5945 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: „ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Building .fixtures
hut ' bailie Permit Application , 0 FOR OFFICE USE ONLY
i. p
City of Tigard 4 y " Received�j _ >•' Permit
13125 SW Hall Blvd., Tigard, OR t " t Date/By: 9 ,Z 11 y Permit No. r? Q c --46 gi
/ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ��� )) I Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 �, "� ■/ .�
Internet: www.ci.tigard.or.us R�� � - --+ Date Ready/By: hair, 61 See Page 2 for
� Notified/Method: „-r- 1 ( r- Supplemental information
' • _ - - TNPE'i : li y � �•� 1 r-
• FEE• •SCHEDIILE . .
Ncw construction G1 ti�p�]] �A•i•
01111-0° J'De molition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 R for each unlit) connection)
CATE OR-CONSTRUCTTON ;•'''• SFR (l) bath 249.20
- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder ❑Other
Fire sprinkler ( sq. ft..) Page 2
,-, .. JOB'S['- 'E:ii .FFORMATi07 i,. '1i.;..L•O , '
. � Site utilities
Job site address: /do Sa S w w In.. s tiers Loop Catch basin or area drain 16.60
City/State/ZIP: -' 6g_ y'7 3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear R.. ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
(A .0 � /) y Manholes 16 60
s t 1. I �- V L Rain drain connector 16.60
Sanitary sewer (no. linear ft.. ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision(f,j S fie/2S W c i./G 7 L I Lot no.: (p Water service (no. linear R.: ) Page 2
Fixture or Item
Tax map /parcel no.: (P SS 6
Absorption valve 16.60
/ 'DESCRIPTION OF ; WORK , z- , Backflow preventer I Page 2 ,Z7. S
�n/'1 s, GC��, r rr/ 0 of L 1) 1 bo f---/014:1 c /��;: / /' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPEBTI'rOW1VER ; ' Drinking fountain 16.60
. • • ..I :•.:. s f* :. io= �_ ... -
Ejectors/sump 16.60
Name: b 0- Y1 /c' S S C ; /- tc C. - Expansion tank 16.60
Address: t.-f2 3 L• S L &e e Le.) 0 (iC::
L Fixture/sewer cap 16.60
City/State/ZIP:[ Cz X C. C% S LC Cc/0 OA- y'7 S Floor drain/floor sink/hub 16.60
Phone: ( ) F ax: ) Garbage disposal 16.60
APPLfCAN'I`' ' - . ' ICUPFTACT PERSON '' Hose bib 16.60
/ � Ice maker 16.60
C1
Business name: �r, C( S e`[ ,<„, or-ego-In Jamel [a
name: ! .> ( "�
Contact nam Interceptor/grease trap 16.60
:✓ r „/1 J (r 6...,-, f L Medical gas (value: $ ) Page 2
Address: a e>v I g
� s . � rY,t�,C.,«y, y �� Primer 16.60
City/State/ZIP:-VA/ /Lb& ok, ■ 1 7�'& `L Roof drain (commercial) 16.60
cr < < Sink/basin/lavatory 16.60
Phone:
(5 3) (c i:� - S i 9c/S Fax: (Se 3) & i ' - 0 ) ( c S� Tub /shower /shower pan 1660
E -mail: -
Urinal 16.60
: • CONTRACTOR , - , . 1 Water closet 16.60
Business name: ��f1KSe�f) L �LiG� n C Water heater 16.60
Address: f ;,..\)-60 S /!) f) �S,!(5 / Y Othe
City /State/Z1P: ? 6 - �n _ 02 »v6 �-- - Snbtot
Minimum permit fee: $72.50 0
Phone: (5C./.3) ( /� S'9�/S Fax: 6 (4 - 07 (0 g Residential backflow minimum permit fee $36.25 3 Ca ' 02 S
CCB Lie.: 7 ec, Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signa
l u�
L � State surcharge (8% of permit fee) , 9U
TOTAL PERMIT FEE 1 8q, ( 5'
Print name - ,CG11UUJ Dat . f. This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
i SnildmglPernitstPL .MF- PermitAppdoc 12/03 440 /07JCOM/WEB)
- a -d -- - e92:80 bO L2 2fEl
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: . (503) 639 -4171 MST
BUP
Received Date Re I uested 4 AM PM BUP '\ •
Location /.?\ v S� cR A� Suite MEC -
Contact Person Ph ( ) PLM' OD g
Contractor Ph ( ) SWR - •
BUILDING Tenant/Owner , - - ELC-
Footing
Foundation . ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: f SIT
Post & Beam ,._
Shear Anchors _ __
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
-
Final
PASS PART FAIL
PLUMBING 1 -- --77 (r Post &Beam
ELe ;
Sanitary Sewer / ,
Rain Drains ' ,
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: , r f
agy . PAR FAIL y
� ( /,
V'' ' HANICAL
Post & Beam -
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL ,
■
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA h
Approach /Sidewalk Date 14/ I ' L -_ Inspector ' G2 - Ext
Other:
Final DO NOT REMOVE this Inspection - record from the Job site. - i
PASS PART FAIL